Medicine in the Early 18th Century

… medicine was unabashedly aggressive; in an attempt to be heroic, it was more often horrific.

A very few practical men had begun systematically observing their patients and describing symptoms that clustered into specific maladies. The most eminent physicians of the day, however, were abstract philosophers who snipped and stretched experience to fit theory, in their case a modified version of the ancient Greek theory of the four humors. Good health, in this system, was a perpetual circus act, balancing ever-shifting quantities of blood, black bile, green bile, and phlegm, as well as the oppositions of hot and cold, moist and dry. Imbalances tipped people into the morass of sickness; restoring a patient to health meant bringing them back into balance.

To do so, doctors tried to relieve whatever the body was producing in too much abundance by either repressing or removing it, while nurturing the growth of whatever they judged to be lacking. It was the relief side of this equation into which medicine had long put most of its efforts and its faith–though relief proves a bizarrely inopportune word for their ministrations.

Any and all possible bodily emissions were sometimes thought necessary to force. The most commonly practiced “evacuation” was bloodletting: slitting veins open at the wrists, arm, groin, or in serious cases, the jugular, to let poisons escape with the blood. If all else failed–or, in the delicate cases of infants, right at the beginning–doctors applied leeches to the temples or behind the ears. They also induced sweating, salivating, and blistering, and they administered clysters, or enemas and ferocious laxatives and diuretics. An unholy array of emetics produced immediate and sometimes prolonged vomiting. Many, if not most, of the medicines they put into a body were designed to send something else shooting out of it, making eighteenth-century medicine a leaky, spraying, spewing art.

It was an art, furthermore, divided into three territories with jealously—though often unsuccessfully—guarded boundaries. Physicians were university men with medical doctorates. High (and highly expensive) priests of the mysteries of diagnosis, they solemnly prescribed treatments but rarely provided them, though things were changing in progressive and ruthlessly practical places like Edinburgh, or the University of Leiden over in Holland. In London, any procedure, such as bloodletting, that involved cutting was still by law the purview of the surgeons–historically, a specialized branch of the razor-bearing brethren of barbers, with whom they shared a guild until 1745. In contrast to the learned doctors, a surgeon was a mere “Mr.” who learned his trade by apprenticeship. The men who concocted the potions and powders that physicians prescribed were the apothecaries, or pharmacists. Scurrying through the cracks in this system was an army of panacea-peddling quacks, mountebanks, and empirics.

Wealthy patterns not only paid all three of the proper medical professions to dance attendance at their sickbeds, as a kind of status symbol of conspicuous consumption, they consulted multiple physicians. Poorer people made do with surgeons, apothecaries, local wisewomen or nurses, and the potions of the quacks: and were often better off for it.

Thoughts:

Things seem not to have changed radically in terms of practice (as opposed to theory or the specifics of iatrochemistry–chemical medicine–in practice, for example) since the time of Paracelsus, so it seems. Or, at least, that’s my impression based on the book on Paracelsus that I mentioned here. Physicians in Paracelsus’ time were also married to the classics, the notion of the four humours, and all kinds of error contained in Agrippa and Galen, to the point where when the anatomical contents of multiple corpses imperfectly matched what classics described, the discrepancy was explained in terms of “imperfections” in the corpses (and the fallenness of the world) rather than as mistakes in the texts. Silly as it sounds to us, people took the Quarrel of the Ancients and the Moderns seriously… which is to say, they really disputed whether there was anything new under the sun to be learned or understood. Obviously, the moderns won. (Thank goodness.)

The “local wisewomen” Carrell mentions are what I’ve been referring to here on the blog as Cunning Folk, that is, folk magic practitioners–not all of whom were women, incidentally. Presumably Carrell means that in consulting with such individuals, the poor were “deprived” of the useless, painful, and humiliating treatments of eighteenth-century doctors, not that the folk magic actually worked. (Sure, some of the herbal remedies might have been useful some of the time, but a lot of cunning folk practice actually involved all kinds of folk magic like inscriptions on bits of paper worn about the neck and so on, as Jim Baker explains in his exhaustive and wonderful The Cunning Man’s Handbook, a book I discussed here, among other places on this site.)

If you know anything about traditional Asian medicine, you’ll see a striking parallel between its theories of energy-flow blockages and bodily imbalances, and the Western idea of humoral imbalance discussed above. Actually, the amount of folk magic I ran across in Baker’s The Cunning Man’s Handbook that had parallels in Korean folk beliefs, folk medicine, and other superstitions was kind of staggering, even including specific dream interpretations and a form of bloodletting, albeit less aggressive in its Korean form at least. (I discovered a number of those parallels while discussing Baker’s book with Mrs. Jiwaku and another Korean friend who was visiting us in Vietnam late last year.) Hell, South Korean society actually feels to me like it’s having its own Quarrel of the Ancients and the Moderns today, actually: “oriental medicine” (based on theories of unmeasurable, undetectable “energy flows” and the purgation of “bad blood,” as well as the ingestion of medications devised on the lines of of sympathetic magic) is regarded institutionally as legitimate, but many people blame many social ills on Confucianism or on thinking that dates back to the Joseon Dynasty, which is revered and criticized in turns, in ways that relate to today’s problems. 1

Note, however, variolation–the rudimentary form of inoculation that Carrell’s book discusses–was taken from “oriental medicine” as well. Mind you, in this case, it was Oriental in the sense of the Near East: inoculation against smallpox was practiced in Turkey, where Lady Mary Wortley Montagu and others encountered it. Which is to say that not all folk medicine is completely useless. Variolation alone–the unsanitary, dangerous folk medicine practice Lady Mary had performed on her own children–was a massive innovation, upon which others built.2 Unsurprisingly, we (rightly) remember Edward Jenner for considerable life’s work in the area of vaccination, but forget how he built on the work of others like Lady Mary Wortley Montagu and her family’s physician, Charles Maitland, let alone those perhaps-forgotten non-Western innovators who figured out inoculation. Here’s a more complete recounting of the whole story… or, well, a lot of it, anyway.)

But that more complete recounting is missing some crucial material on Lady Mary Wortley Montagu–and what she’d say about the idiotic “vaccination debate” of today–that Jennifer Lee Carrell manages to include in her book. More on that soon…

And yes, for the record, I’m saying that a lot of “traditional Korean medicine” involves nonsensical magical ideas. Maybe not all of it, but a great deal of it. I’m leerier about the equation of Western with “modern,” though I can understand the historical reasons why it might look like that to some South Koreans. And, really, if the Quarrel of the Ancients and Moderns boils down to the unseating of Aristotle and the Bible as the ultimate authorities of all knowledge, then the Quarrel is alive and well in the West, too–otherwise there would be no dispute over the teaching of evolution in schools. Indeed, I feel like it’d be much harder to cling to Intelligent Design for someone who knows about the Quarrel and how the Ancients have fared over the last few hundred years, as the moderns have steamrolled flat one after another ideological stronghold of the Ancients.↩

And if Mickey Mouse and crappy pop hits are deserving of eternal copyright, as Sonny Bono once suggested, then so is inoculation… but we don’t see the pharmaceutical giants of the world pay royalties to the Turks, do we?↩